Tuesday, June 19, 2012

Kenyan hospital

This is kind of a saga. It's the first time that one of my kids has been sick, so I'm sure I'm a little more emotional because of that. But, still. It's a doozy. We only saw doctors in the US for well visits, but I rather think they would have treated this illness differently.

Ben had a fever Friday evening. It was 101-102, but went down with paracetamol. Saturday morning, it was 99.5, so we decided not to take him to the doctor. Going to the doctor in Kenya is actually going to the hospital. There are neighborhood clinics, too, but it's better to go to the doctor at the hospital.

Saturday afternoon, his temperature was going up again, so Rodgers took him to the children's hospital. We don't have a lot of faith in them, but they are our best option right now.

A young doctor examined Ben, said his sinuses and ears were clear, but he had some inflammation in his throat. He would not specify which part, just that it was in his throat. They drew blood, which they always do when a kid comes in, so that they can look at the white blood cell count. This young doctor left the hospital after giving Rodgers the lab orders. Rodgers called me at that point, and I assumed the lab orders included a strep swab. Nope. They don't do those; just a white blood cell count.

The supervising doctor (SD) then took over. He never looked at Ben; he just read the file. This is normal. Only the  newer doctors and nurses actually look at the kids. They make their notes. Then either this SD or the head doctor (and owner of the hospital) reads the file and makes the final decisions.

The SD told Rodgers that Ben had a viral infection in his sinuses. Rodgers argued that the other doctor said differently. The SD wouldn't hear it. He was reading the file. He told Rodgers what virus it was, but Rodgers couldn't remember the name later. He did remember the symptoms, none of which Ben had besides fever. SD then told Rodgers that Ben needed to be admitted to the hospital for a few days. Rodgers asked why, but the SD couldn't give a reason, so Rodgers refused. Our confidence in their competence had dropped considerably.

The SD reluctantly sent Rodgers and Ben home, with several types of medicine. He had something like ibuprofen, antibiotic, saline nasal drops, and another nasal drop. Having been told Ben's sinuses were clear, though the SD said the file said differently, we weren't sure about giving him the nasal drops - I didn't even know what kind of medication they were (besides the saline). I also didn't want to give him an antibiotic when we were told he had a viral infection, regardless of the fact that he had no symptoms of that virus. We just didn't really know what to do. His temperature was down for the moment, so we put him to bed and started googling the medications to find out what we'd been given.

Rodgers called the receptionist at the hospital, to find out if the name of the virus was written in Ben's file. Then, at least, we could look that up and see what we were (potentially) dealing with. The file said that it's a bacterial infection. Which bacteria? Well, to find out, we'd have to do a culture, and that takes a long time. (Later we were told that they just don't do cultures for babies unless it's for research because it doesn't much matter what the kid has [whether it is bacterial or viral and what type], they are going to treat it the same way - antibiotics.)

So, we started giving Ben the antibiotic Sunday morning. Towards the afternoon, he sounded congested, so we started the nasal drops then. Not long after that, his temperature went up, fast. He was playing one minute and could hardly hold his head up the next. His temp was over 104, so Rodgers took him back to the hospital, after I gave him some more paracetamol.

They gave him IV antibiotics and a fever reducer (he hasn't run fever since then). Again, they refused to do anything to determine what Ben was actually sick with, but they did want to do a finger prick/blood smear to test for malaria, again (they did it Saturday, too). They insisted that Ben be admitted. Rodgers called me then, to tell me Ben was being admitted, and the doctors were refusing to determine what the infection was.

One of our friends came to get Nate and me later, so that we could go up to the hospital. I could make sure that Ben wasn't dying, and Rodgers could tell me what was going on.

I stayed with Ben in the hospital overnight, and Rodgers took Nate home to sleep. He seemed to be fine, but couldn't rest well, with other kids screaming all the time, people slamming doors, and the lights being on 24/7. We were in a semi-private ward, which was better than the general ward, but still not a place conducive to recovery.

Monday morning, Rodgers and Nate came back, and we started trying to get discharged. They still wanted to keep us until Wednesday or Thursday. Ben did obviously need the IV antibiotic on Sunday, but now that he'd had it, he was fine. Staying in the hospital would prevent him from being able to rest, as well as expose him to other illnesses when his immune system was already fighting an infection. Not to mention that it was an unnecessary expense for us. Being that Ben was in the higher-priced semi-private ward, we knew they wouldn't let him go willingly.

Around noon, the owner of the hospital finally came in. She wanted to be the one to discharge Ben, if he was to be discharged. I think she knew we weren't happy with their refusal to diagnose him or with their standard of care.

She asked when we started giving him the medications at home. I told her when. She was confused. The doctor had given us those meds and told us to give them to Ben. The doctor! I told her why we didn't want to give them, that they didn't correspond with what we'd been told Ben was sick with. She then proceeded to explain why we were given those medications. They won't do a throat or nose swab to test for bacterial infection because there are just so many types of bacteria present normally. Yes, Ben had a bacterial infection, but he would have been given antibiotics for viral infection, too. You see, in Kenya, the weather is different than in the US, so they have to treat everything with antibiotics. She said that some people from the US Embassy in Nairobi come to Mombasa from time to time. They were recently interviewing hospital owners to determine where they would take their kids if they needed a doctor while in Mombasa. They asked how often she gives antibiotics. She told them the same thing about the weather being the reason they give antibiotics for everything and that at least 80% of her patients will be given antibiotics. It doesn't really matter what the actual diagnosis would be (if they bothered to determine one), they just give them antibiotics. Her theory for Ben's infection is that it was caused by the weather.

We insisted she discharge Ben, and she did. It took a few hours to get out of there.

Ben has been happy at home, sleeping well in his own bed. This morning, he wants to play with his brother, but he's still very tired (recovering from being sick in addition to recovering from getting very little sleep in the hospital). He eats well, and he hasn't had any fever since that first dose of IV antibiotics.

I'm very curious where the US Embassy people will take their kids to the doctor while they're in Mombasa. We haven't found anything better than this place, yet, though we do have phone numbers of two other pediatricians we will check out. We already didn't have much faith in them, and so far, they have done nothing to inspire confidence.


  1. Hi, got your blog as I was looking for diaper cake pictures and started reading.

    Sorry about your experience and I believe from your story that you are talking about Karen Hospital?? Might be wrong....

    Sadly, I can't instil further confidence in you about the hospitals and doctors in this country [said by a born and bred Kenyan].

    They are known to ask for tests that are not needed, doing surgeries that are not needed and prescribing the wrong drugs.

    Your best bet is finding a doctor who is your friend and ALWAYS getting a second opinion.

  2. Ok... just re-read that post. Not Nairobi. But the fact still remains! :-)